Ask Emily: Change and no change at the health insurance exchange

I'm sure you've heard that premiums for plans sold through our health insurance exchange, Covered California, will go up an average of 4.2 percent next year.

Just remember, "average" means just that. Your premium increase (or decrease in some cases) will depend on a variety of factors, including where you live and what plan you choose.

Consider the following questions, based on issues that many of you have struggled with:

• Was it easy to enroll in your new plan (or Medi-Cal)?

• Did the Covered California website work for you?

• Have you been able to see a doctor who will accept your new coverage?

• If so, how long did it take?

• How much do you pay for prescription drugs?

• Have you been hit by unexpected medical bills?

In today's column, I'll explain what you can expect from next year plans, beyond the premiums.

If you buy your health insurance from the private market, you should pay attention to this, too. All plans sold through Covered California must be sold on the private market at the same price.

ENROLLMENT: If you have a Covered California plan, you can keep it without reapplying, said Covered California Executive Director Peter Lee.

If you're not happy with your plan, you can switch. Open enrollment runs from Nov. 15, 2014 through Feb. 15, 2015.

PLAN CHOICES: Ten plans will be offered around the state, with options varying by region. They're the same as this year's, minus the Contra Costa Health Plan.

NETWORKS: Among the biggest challenges many of you faced this year were "narrow" networks, in which some plans significantly limited the number of participating doctors and hospitals.

Lee said Covered California is working with plans to ensure their provider directories are accurate and have encouraged them to expand the number of participating doctors, hospitals and medical groups.

The day before Covered California unveiled 2015 rates, Anthem Blue Cross announced that it has added 6,300 doctors to its Covered California plan network since Jan. 1.

PLAN BENEFITS: If you had any beefs with your plan benefits and hoped they would change next year, you're out of luck, with one important exception.

Dental insurance for children will be embedded into all plans, which wasn't the case this year, Lee said. Supplemental dental insurance for adults also will be available, he said, but as an add-on item.

Otherwise, benefits remain the same, such as the potentially expensive prescription drug pricing tiers and some plans' exorbitant out-of-pocket maximums for out-of-network use.

RATES: About half of Covered California participants will see their rates go down, stay constant or rise less than 5 percent; 36 percent will see premium increases of 5 percent to 8 percent; and 13 percent will see rates rise more than 8 percent.

So much of pricing is local, and California is chopped into 19 different pricing regions. The average increase for San Francisco County is 6.6 percent, whereas the average increase for a region that includes five Central Valley counties is actually a decrease — minus 1.9 percent.